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Hospital Ignores Woman’s Known Disability, Causes Brain Damage | Palm Coast Malpractice Attorney

Hospital Ignores Woman’s Known Disability, Causes Brain Damage

This mother took all the precautionary steps to protect her disabled daughter from any complications from surgery that might result from her rare form of diabetes.

She reminded the surgeon and the resident assisting him of her daughter’s diabetes two weeks prior to the surgery. She personally spoke with the anesthesiologist about the need to monitor fluid levels. She spoke to a floor nurse after the surgery, reminding the nurse of her daughter’s special condition and even handed her a medical information sheet to help with her care.

Despite this mother’s best efforts to help her disabled daughter, her rare medical condition was practically ignored during her time in the hospital after the successful surgery. As a result she suffered post-operative brain damaged and is no longer able to communicate with her family.

This 23-year-old woman had a history of multiple birth defects and was scheduled for hip surgery. She was non-verbal (but could communicate with facial expressions, and in limited fashion via a computer translator) and dependent on family members for all aspects of daily living.

She also suffered mild diabetes insipidus (DI), also known as “water diabetes.” DI is a rare disease in which the kidneys produce abnormally large volumes of diluted urine. This woman’s DI was managed at home by her mother with careful attention to her fluid intake. Three years before this surgery, she had undergone a similar orthopedic procedure and had an extended admission due to hypernatremia, or elevated sodium levels in the blood.

At the pre-op appointment two weeks before surgery, the woman’s mother reminded the surgeon — and the resident assisting him — of her daughter’s DI and her previous post-op complication. They acknowledged her concern, and the attending told her to make sure the anesthesiologist understood. The mother spoke with the anesthesiologist that same day.

Upon admission, the woman’s DI was recorded by the nurse practitioner on the anesthesia assessment form. And due to the woman’s DI, the anesthesiologist closely monitored her electrolytes during surgery.

Halfway through the surgery, the resident surgeon was called to another case. An orthopedic fellow, who did not know the patient, took over and the surgery was completed successfully. Immediately after the surgery, the attending surgeon left for vacation.

The fellow wrote the post-op orders but — not being familiar with the woman’s medical history — did not include serial labs or adequate fluid intake. The PACU nurse did not pay attention to the woman’s fluid balance or electrolytes. The young woman was transferred to a floor where the nurse was unaware of the woman’s DI.

The next day, the mother told the nurse on duty that her daughter had DI. She gave her a worksheet of what her daughter’s hour-by-hour fluid intake should be. This nurse made note of it, but did not follow up on it, assuming the physician’s orders covered the woman’s needs.

The orthopedic resident visited the patient each post-op day. Four days post-op, she became drowsy and withdrawn and experienced seizure-like activity. Not understanding DI, the nurses had not documented when the woman was becoming more withdrawn.

When the woman slipped into a coma and developed aspiration pneumonia, a review of her chart indicated her sodium levels had gone unchecked for three days. Testing showed it at 185. She was transferred to the MICU where, over the course of several days, her electrolyte and fluid imbalance was corrected.

The woman suffered brain damage and can no longer communicate in any fashion with her family. She now lives in a long-term nursing home.

This case was settled for more than $1 million against the orthopedic surgeon for the delayed diagnosis and treatment of postoperative complications resulting in dangerous elevation of serum sodium levels and permanent brain damage.

This was a successful lawsuit based on the following factors:

This non-verbal woman, with a complex medical condition, was treated as a routine patient. A complicated patient with potentially lethal chronic conditions requires extra planning and coordination with other providers to ensure the best possible outcome.

The lead surgeon scheduled a vacation immediately after this elective surgery, with no oral or written instructions for managing the DI. While elective surgery should be scheduled when the surgeon will be present for post-op care, reliable care should not be dependent on one practitioner. Reviewing a patient’s complicated condition with a covering physician can lead to a good monitoring plan.

No plan was made for monitoring the DI post-op. Mandatory consults for certain serious conditions offer needed expertise. Care plans should go with the patient across care sites and feature all clinical risk issues.

The woman’s mother was closed off from nurse conversations about fluid intake and output. The best care processes require developing a system to capture and utilize input from patients and families at critical care points.

This woman’s care was characterized by assumptions. The attending surgeon assumed the mother would tell the anesthesiologist about the DI or that covering physicians would consider it during post-op care. The floor nurse assumed post-op orders addressed anything the mother was worried about, etc.

This event compounded the woman’s deficits. It changed her ability to communicate with her family and to recognize others. The surgeon was responsible for post-op care, which included monitoring her pre-existing condition. The lack of monitoring led to permanent damage.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

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